title: Targeted drug-resistance testing strategy for multidrug-resistant tuberculosis detection, Lima, Peru, 2005-2008.
abstract: The Peruvian National Tuberculosis Control Program issued guidelines in 2006 specifying criteria for culture and drug-susceptibility testing (DST), including district-level rapid DST. All patients referred for culture and DST in 2 districts of Lima, Peru, during January 2005-November 2008 were monitored prospectively. Of 1,846 patients, 1,241 (67.2%) had complete DST results for isoniazid and rifampin; 419 (33.8%) patients had multidrug-resistant (MDR) TB at the time of referral. Among patients with new smear-positive TB, household contact and suspected category I failure were associated with MDR TB, compared with concurrent regional surveillance data. Among previously treated patients with smear-positive TB, adult household contact, suspected category II failure, early relapse after category I, and multiple previous TB treatments were associated with MDR TB, compared with concurrent regional surveillance data. The proportion of MDR TB detected by using guidelines was higher than that detected by a concurrent national drug-resistance survey, indicating that the strategy effectively identified patients for DST.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Gustavo E
authors.initials: GE
authors.lastname: Velásquez
authors.forename: Martin
authors.initials: M
authors.lastname: Yagui
authors.forename: J Peter
authors.initials: JP
authors.lastname: Cegielski
authors.forename: Luis
authors.initials: L
authors.lastname: Asencios
authors.forename: Jaime
authors.initials: J
authors.lastname: Bayona
authors.forename: Cesar
authors.initials: C
authors.lastname: Bonilla
authors.forename: Hector O
authors.initials: HO
authors.lastname: Jave
authors.forename: Gloria
authors.initials: G
authors.lastname: Yale
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
authors.forename: Sidney
authors.initials: S
authors.lastname: Atwood
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Contreras
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008403:Mass Screening / Q000379:methods*; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D010568:Peru / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012293:Rifampin / Q000494:pharmacology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid; D012293:Rifampin